The last 3 decades have witnessed a major evolution in the treatment of advanced-stage Hodgkin lymphoma (HL). The most prominent of these developments include the introduction of the international prognostic scoring (IPS) system; therapeutic decision-making based on both IPS and interim PET/CT data; the finding that a negative interim PET/CT result could be safely used for treatment de-escalation; the introduction of intensive combination chemotherapy like escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin (vincristine), procarbazine, and prednisone); and further modification of this protocol with the incorporation of a conjugated anti-CD30 antibody brentuximab vedotin (BV) into first-line regimens, like BV-AVD (BV+ adriamycin, vinblastine and dacarbazine) and BrECADD (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone). The accruing data about the toxicity of the escalated BEACOPP protocol have led to decreasing the number of therapeutic cycles, substitution of toxic agents like procarbazine with dacarbazine (e.g., BEACOPDac), and reduction/omission of radiation therapy. Lately, a significant advancement has been made by the integration of checkpoint inhibitors in the first-line treatment, with preliminary results demonstrating the superiority of anti-PD1 combined with chemotherapy (nivolumab-AVD) compared to the BV-AVD regimen. This review aims to analyze recently published studies whose findings could change the treatment practice in advanced-stage HL.
过去三十年间，晚期霍奇金淋巴瘤（HL）的治疗模式经历了重大演变。其中最显著的进展包括：国际预后评分（IPS）系统的引入；基于IPS和中期PET/CT结果的临床决策；中期PET/CT阴性结果可安全用于治疗降阶梯的发现；强化联合化疗方案如升级版BEACOPP（博来霉素、依托泊苷、阿霉素、环磷酰胺、长春新碱、丙卡巴肼和泼尼松）的应用；以及通过将抗CD30抗体药物偶联物维布妥昔单抗（BV）纳入一线方案（如BV-AVD方案[维布妥昔单抗+阿霉素、长春花碱和达卡巴嗪]及BrECADD方案[维布妥昔单抗、依托泊苷、环磷酰胺、多柔比星、达卡巴嗪、地塞米松]）对该方案的进一步改良。关于升级版BEACOPP方案毒性的累积数据促使临床实践出现以下调整：减少治疗周期数、用达卡巴嗪替代丙卡巴肼等毒性药物（如BEACOPDac方案）、以及减少或省略放疗。近期，免疫检查点抑制剂融入一线治疗取得重大突破，初步研究显示抗PD1抗体联合化疗（纳武利尤单抗-AVD方案）相较于BV-AVD方案更具优势。本综述旨在分析最新发表的可能改变晚期HL临床实践的研究成果。
肿瘤(癌症)患者之家